Rocca WA et al. Increased risk of cognitive impairment or dementia in women who underwent oopherectomy before menopause. Neurology 2007; 69:1074-1083.
editorialHogervorst E. Should surgical menopausal women be treated with estrogens to decrease the risk of dementia? Neurology 2007; 69: 1070-1071.
article is from Mayo Clinic in Minnesota. Surgical menopause increases the risk of dementia or cognitive impairment by 45 % in a large observation followup trial. With unilateral surgery before age 41, there was double risk, before age 34 there was four times risk, for bilateral surgery before age 46 without treatment there was 82 % increased risk, but if estrogens were given till age 51 (natural menopause age) the risk for dementia was not significant. After age 51, the effects of estrogens were not protective against dementia. A prior study showed a benefit in patients up to age 58 with bilateral surgery. Editorial emphasizes that the effects of treatment are beneficial only for a short period of administration of drug (3-12 months). Estrogens are not indicated for this purpose in women above age 60. The author of the editorial proposed to investigate genetic polymorphisms in women with AD which are associated with altered sex steroid metabolism and synthesis, especially CYP 1B1 (Leu432) and COMT Met/Met to explain why some older women have an increased risk of AD when they receive HRT for a longer period of time.
